Scribd
Upload
4 views

Form F

The document outlines the nomination process for gratuity payments under the Tamil Nadu Payment of Gratuity Rules, 1973. It includes a form for employees to nominate individuals to receive gratuity after their death and requires details about the employee and nominees. The document also includes sections for witness declarations and employer certification.

Uploaded by

coordinator
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
4 views

Form F

The document outlines the nomination process for gratuity payments under the Tamil Nadu Payment of Gratuity Rules, 1973. It includes a form for employees to nominate individuals to receive gratuity after their death and requires details about the employee and nominees. The document also includes sections for witness declarations and employer certification.

Uploaded by

coordinator
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

THE TAMILNADU PAYMENT OF GRATUITY RULES, 1973

FORM - “F”
See Sub – rule (1) of rule (6)
Nomination

To

( give here name or description of the establishment with full address )

1. I Shri / Shrimathi / Kumari _______________ (Name in full here) whose particulars


are given in the statement below, hereby nominate the person(s) mentioned below to
receive the gratuity payable after my death and also the gratuity standing to my credit in the
event of my death before that amount has become payable, or having become payable has
not been paid and direct that the said amount of gratuity shall be paid in portion indicated
against the name(s) of the nominee(s).
2. I hereby certify that the person(s) mentioned is a / are member(s) of my family within the
meaning of clause (h) of section 2 of the payment of gratuity Act, 1972.
3. I hereby declare that I have no family within the meaning of clause(h) of section 2 of the
said Act.
4. (a) My father / mother / parents is not dependent me.
(b) My husband’s Father / Mother / Parents is not dependent on my husband.
5. I have excluded my husband from my family by a notice dated the
......………to the controlling authority in terms of the provision to clause ( h)
of section 2 of the said Act.
5. Nomination made herein in validates my previous nomination.

NOMINEE(S)
Proportion by
Name in full with address of Relationship with Age of
Sl. which the gratuity
the Nominee(s) the employee Nominee
No will be shared
(1) (2) (3)
(4)

1.

2.

3.

4.
So on

1
STATEMENT

1. Name of the employee in full :


2. Sex :
3. Religion :
4. Whether unmarried/ Married/ widow/ widower :
5. Department / Branch / Section where employed :
6. Post held with ticket or serial No. … if any :
7. Date of appointment :
8. permanent Address :
Village : Nearest police station : Taluk :

District : State : Post office :

Place : Signature / Thump impression

Date : of the employee


___________________________________________________________________________

DECLARATION BY WITNESS

Nominated signed / thump impression before me.


Name and address of witness Signature of witness
1.

2.

Place :

Date :
____________________________________________________________________________

CERTIFICATE BY THE EMPLOYER


Certified that the particulars of the above nomination have been verified and recorded in this
establishment.
Employer’s reference if any
Signature of the employer /
Officer Authorised designation

Name and address of the Establishment


Date : Or rubber stamp there of
____________________________________________________________________________
ACKNOWLEDGE BY THE EMPLOYEE
Received the duplicate copy of nomination in Form “F” filled by me and duly certified by the
employer.

Date : Signature of the employee

Strike out the words / paragraphs not applicable.

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy